Neuroangiography and Stenting
Angiography is a medical term that means the visualization of blood vessels.
Neuroangiography refers to the visualization of the blood vessels of the central nervous system.
The clinical use of neuroangiography dates back to late 1800’s and early 1900’s. At early periods, it had been solely used for diagnostic purpose, as imaging methods were not well developed and there was no means of intravascular access. As imaging methods (computed tomography and Magnetic Resonance Imaging) had developed over time, it could be possible to avoid unnecessary invasive procedures and doctors had the opportunity to treat vascular disorders that are identified in the neuroangiography. On the other hand, developments in angiographic devices allowed the technique to offer more effective treatment results. At the latest stage, state-of-the-art imaging methods enable accurate diagnosis and accordingly, neuroangioraphy is largely reserved for invasive procedures.
Today, Neuroangioraphy is a top-end invasive procedure that allows diagnosis and treatment, if possible, of vascular diseases in the central nervous system by Interventional Radiologists and Neurosurgeons.In the early evolution of neuroangiographic imaging, cervical carotid artery was directly punctured; however, arteries of arm and groin are now used thanks to advanced catheterization and imaging technology.
Why is this procedure done?
Neuroangiography may diagnose and treat a wide range of disorders, including both extracranial (vertebrobasilar insufficiency, stenosis of carotid artery) and intracranial (aneurysms in arteries of central nervous system, arteriovenous malformations, stroke, tumor embolization) diseases.
Moreover, as neuroangiography is associated by serious risks (stroke, cerebral hemorrhage, air embolism, thromboembolism, transient blindness, amnesia, renal failure and fistula), patient selection and comprehensive preparation are of great importance.
Nevertheless, since the primary goal is to minimize damage to the patient for all diseases, non-invasive imaging methods (e.g., CT and MR Angiography) are used before a neuroangiographic imaging or intervention is considered.
The possible risks of a diagnostic and therapeutic neuroangiography are listed below:
• Cerebral hemorrhage
• Air embolism
• Transient blindness
• Renal failure
• Fistula formation
• Reversible or irreversible damage to nervous system
• Allergic reaction against contrast agent
In the neuroangiography suite, any and all necessary instrument, equipment and other means to manage the possible risks and complications are available.
Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.
Our specialists will employ all practices to minimize the risk of complications and our doctors will preoperatively inform you about risks listed above and all other potential complications and will address all your concerns.
A number of comprehensive examination is required to decide whether neuroangiography is indicated.
Before the procedure is performed, your health history is reviewed and a comprehensive physical examination is done, in which all your vital signs (pulse, heart rate, breath rate, core temperature, etc.) are evaluated.
Necessary laboratory tests and radiology studiesAssessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications
The time you will stop eating and drinking will be instructed. Medications you take for diabetes, hypertension and other disorders are reviewed. You are informed about medications that you should take in the day of the procedure. Besides, you should also inform your doctor about all over-the-counter medications, herbal products and vitamin and mineral supplements.
Since contrast agent is used for the imaging phase of the procedure, your past history is reviewed regarding allergic reactions against the contrast agent.
Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.
Surgery and early postoperative period
After you have been taken to the suite for the procedure, you will be positioned on the procedure table. There are mobile imaging devices that can move around the table to capture images. One or even two (if intervention is planned) IV lines are inserted to allow intravenous treatments and administer medications, if necessary. At this stage, a sedative agent is administered to make you fall into a nap.
All your vital signs will be closely monitored using ECG, pulse oxymeter and anesthesia monitor.
First, a sheath is inserted into an artery in order to image arteries of the central nervous system. This sheath enables quick change of catheters. Next, a hydrophilic guide wire is inserted. Then, a thin tube, called a catheter, is inserted into the artery over the guide wire. The catheter is advanced over the guide wire to the target segment. A contrast agent is administered through the lumen of the catheter and images of artery(ies) are captured by an imaging device and viewed on a monitor, both available in the procedure room. Intracranial navigation can also be used for neuroangiographic procedures.
Once images are captured on necessary projections, various diseases of blood vessels, such as aneurysm, malformation, stenosis, fistula and atherosclerosis, are treated. A stent is inserted, if necessary, to maintain blood flow in the artery. If deemed appropriate, the diseased vessel is occluded by placing a clip.
For tumor, aneurysm or malformation, the feeder artery is occluded (embolization).
After imaging and treatment phases are completed, the catheter and the guide wire are removed. The sheath, if any, is removed and the small incision is stitched that is made to insert the catheter.
After the neurangiography, you will be transferred to the observation room. Before you are transferred to the patient room, you should be observed here for a while and it should be verified that all your vital signs are stable or within acceptable limits. You may also be transferred to the intensive care unit, if your health requires so, for close monitoring.
Especially if the artery located in your groin is used, bleeding should be carefully monitored and managed after the neuroangiography. For this purpose, it may be necessary to apply compression on the small incision made in the groin.
Discharge after a neuroangigraphy is entirely related to your general health. If there is no any abnormality, you will usually be discharged in the same day or the next day. But, if an abnormality has been identified and intervened, your doctor will want you to stay at the hospital for one night or longer, if necessary.
After discharge from the hospital, if you experience signs of infection such as pain, redness and swelling at the incision site in the groin, significant swelling or bleeding at the catheter site, and if you experience chest pain or shortness of breath, it is a vital necessity to seek emergency medical treatment immediately.
Neuroangiography directly visualizes arteries of the central nervous system to explore an abnormality or a problem.If a problem is identified, it is treated in the same session, if possible.However, there may be a problem that requires a major surgery, and thus, your doctors will have the opportunity to prepare you for the major surgery at elective settings.